1Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo; and.
2Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
J Neurosurg. 2018 Aug;129(2):490-497. doi: 10.3171/2017.3.JNS162984. Epub 2017 Oct 27.
OBJECTIVE Only a few previous studies have investigated subarachnoid hemorrhage (SAH) after surgical treatment in patients with unruptured intracranial aneurysms (UIAs). Given the improvement in long-term outcomes of embolization, more extensive data are needed concerning the true rupture rates after microsurgery in order to provide reliable information for treatment decisions. The purpose of this study was to investigate the incidence of and risk factors for postoperative SAH in patients with surgically treated UIAs. METHODS Data from 702 consecutive patients harboring 852 surgically treated UIAs were evaluated. Surgical treatments included neck clipping (complete or incomplete), coating/wrapping, trapping, proximal occlusion, and bypass surgery. Clippable UIAs were defined as UIAs treated by complete neck clipping. The annual incidence of postoperative SAH and risk factors for SAH were studied using Kaplan-Meier survival analysis and Cox proportional hazards regression models. RESULTS The patients' median age was 64 years (interquartile range [IQR] 56-71 years). Of 852 UIAs, 767 were clippable and 85 were not. The mean duration of follow-up was 731 days (SD 380 days). During 1708 aneurysm years, there were 4 episodes of SAH, giving an overall average annual incidence rate of 0.23% (95% CI 0.12%-0.59%) and an average annual incidence rate of 0.065% (95% CI 0.0017%-0.37%) for clippable UIAs (1 episode of SAH, 1552 aneurysm-years). Basilar artery location (adjusted hazard ratio [HR] 23, 95% CI 2.0-255, p = 0.0012) and unclippable UIA status (adjusted HR 15, 95% CI 1.1-215, p = 0.046) were significantly related to postoperative SAH. An excellent outcome (modified Rankin Scale score of 0 or 1) was achieved in 816 (95.7%) of 852 cases overall and in 748 (98%) of 767 clippable UIAs at 12 months. CONCLUSIONS In this large case series, microsurgical treatment of UIAs was found to be safe and effective. Aneurysm location and unclippable morphologies were related to postoperative SAH in patients with surgically treated UIAs.
只有少数先前的研究调查了未破裂颅内动脉瘤（UIAs）患者手术治疗后的蛛网膜下腔出血（SAH）。鉴于栓塞后长期预后的改善，需要更多关于显微手术后真正破裂率的数据，以便为治疗决策提供可靠的信息。本研究旨在调查接受手术治疗的 UIAs 患者术后发生 SAH 的发生率和危险因素。
评估了 702 例连续接受 852 例手术治疗 UIAs 的患者的数据。手术治疗包括颈夹闭（完全或不完全）、涂层/包裹、夹闭、近端闭塞和旁路手术。可夹闭的 UIAs 定义为通过完全颈夹闭治疗的 UIAs。使用 Kaplan-Meier 生存分析和 Cox 比例风险回归模型研究术后 SAH 的发生率和危险因素。
患者的中位年龄为 64 岁（四分位距 [IQR] 56-71 岁）。852 个 UIAs 中，767 个可夹闭，85 个不可夹闭。平均随访时间为 731 天（SD 380 天）。在 1708 个动脉瘤年中，发生了 4 例 SAH，总平均年发生率为 0.23%（95%CI 0.12%-0.59%），可夹闭 UIAs 的平均年发生率为 0.065%（95%CI 0.0017%-0.37%）（1 例 SAH，1552 个动脉瘤年）。基底动脉位置（调整后的危险比[HR] 23，95%CI 2.0-255，p=0.0012）和不可夹闭的 UIA 状态（调整后的 HR 15，95%CI 1.1-215，p=0.046）与术后 SAH 显著相关。总体 852 例病例中有 816 例（95.7%）和 767 例可夹闭 UIAs 中有 748 例（98%）在 12 个月时获得了良好的结局（改良 Rankin 量表评分 0 或 1）。
在这项大型病例系列研究中，发现显微手术治疗 UIAs 是安全有效的。动脉瘤位置和不可夹闭的形态与接受手术治疗的 UIAs 患者术后发生 SAH 有关。
